Tag Archives: classic

Continuing the countdown of 2013’s top anti-THR liars, we should not forget that THR is not just about e-cigarettes or people who are rich enough to afford them. Smokeless tobacco is still the leading method for THR in terms of number of users and proven efficacy and effectiveness. The World Health [sic] Organization (WHO) — including its International Agency for Research on Cancer (IARC) and Framework Convention on Tobacco Control (FCTC) units — has long been one of the leading liars about smokeless tobacco. While their lying is not as aggressive as it once was (and thus they rank only third this year in spite of their enormous reach), it is still going strong.

This matters because the lies have some influence on the knowledge of people in rich countries — for example, IARC played an important role in tricking people into believing that snus causes cancer to a measurable degree despite the lack of any such evidence. But it matters much more because many poor countries simply take their public health marching orders from the WHO.

Among such countries are India and its neighbors, where there is great potential for tobacco harm reduction of a different kind. Millions of people in South Asia use the dip product gutka and others that are similar to it, and these appear to create so much risk of cancer and other oral diseases that their health impact may be up with smoking. The potential harm reduction that would come from persuading people to switch to smokeless tobacco — an obvious substitute that is low-risk and can be affordably manufactured locally — is enormous. The number of users of those products is in the order of a tenth the number of smokers in the world. Enter the WHO, which erroneously claims that these products are smokeless tobacco (tobacco is one of the ingredients, but clearly not the one that is causing the large health impacts).

Not only does this basically guarantee that there will be no attempt at harm reduction in South Asia, but it then carries back to the rest of the world that is tricked into believing that smokeless tobacco causes risks similar to gutka. This leads to harmful lies like this, where the claim is that smokeless tobacco is 17% as risky as smoking (the absurdity of making a claim that precise, even beyond the fact that it is wrong by an order of magnitude, is a topic for another day). This tends to discourage smokers from switching to this proven low-risk alternative.

The WHO has not spared e-cigarettes from its anti-THR lies, though they are a relatively minor player there, in contrast with being singularly devastating in their history of lies about smokeless tobacco. Hat tip to Clive Bates for compiling this list of tweets, which speaks for itself:

Dishonorable Mention: the Continuumistas

Another tribe of semi-liars are the “continuumistas” (not the best neologism meme ever, but useful), those who persist in mistakenly claiming that there is a “continuum of risk” among tobacco products. This relates closely to the above points about different products and comparative risks. The “continuum” claim may have been made more times in 2013 than in all previous history. However, we did not rank the continuumistas on this list because it not really the same as the other lies: While this is often an anti-THR tactic, in many cases it is not intentional and, indeed, many pro-THR commentators make this error. Still, it is important and harmful, so deserves a mention.

Some of us have been pointing out for years why this claim is wrong and harmful. For more details, read this, but to summarize the key point: Claiming there is a continuum of risk suggests that tobacco products are spread out across the spectrum from zero up to the risk of cigarettes. If someone believes that is true, they try to fill in the space, and so they dramatically elevate the claimed risk from some products, as with that 17%. The reality is that there are basically just two relevant points: cigarettes and “about zero”. The latter includes smokeless tobacco, NRT, and e-cigarettes, as well as abstinence. The risks from all of these are so close that we cannot measure any differences, and so if you were to graph these risks versus smoking, they would all occupy the same dot on the graph.

So what explains the continuumistas in light of that distribution being about as far from continuous as is possible? Some of them are out-and-out anti-THR liars, who are trying to suggest that no one should use the effective and satisfying THR products — or even that such products should be banned — because there is something else that is even lower risk. Historically it was smokeless tobacco that was inaccurately moved into the empty zone between cigarettes and zero, but increasingly it has been e-cigarettes. In many cases this involves absurd made-up numbers (e.g., “smokeless tobacco poses 10% the risk of smoking” or “why reduce your risk by half by switching to vaping when you can eliminate it entirely”), though sometimes it is similarly misleading graphical representations.

The claim is also actively perpetuated by industry in an attempt to muddy the waters and distract from the simple message: “combustion = bad for you; all else that currently exists and matters in the marketplace = no measurable risk”. (In fairness, industry is trying to develop some smoking-like products that might occupy that middle space, with much less risk than smoking but more appeal to many smokers who do not like the smoke-free options; still, this does not make the continuum message accurate.) Regulators also tend to like the notion because they like complication, and it keeps them from having to admit that the best choices — which they are often not making — are quite obvious and simple. Finally, many THR supporters who are trying to position themselves as “moderates” seem to like the concept because it lets them avoid stating the highly confrontational implications of the simple message (“we can all agree there is a continuum of risk, right?… aah, good, so we are all on the same page”).

But whether used as intentional manipulation, a highly-toxic compromise between the truth and politics, or mere thoughtless repetition, the continuumista message is harmful for THR as a classic case of “the perfect is the enemy of the good”. By suggesting that abstinence is perfect and thus “merely” good alternatives are too far away from it, many people are discouraged from taking the good options that are so close to perfect that the difference does not matter.

This analysis, of this blog post, might seem a little more brutal than usual. That is because the author, Cheryl Healton (the former head of the leading anti-tobacco organization, American Legacy Foundation — a fact that is omitted in the introduction of her in the blog in question — and now head of the public health program at NYC), knows the truth. This is not a case of someone who is too innumerate to not know she is lying, or a useful idiot that is being used by the anti-tobacco extremists. Healton is one of the puppet masters who manipulates her useful idiots (like New York Assemblywoman Linda Rosenthal), which she is doing in this post. Notice in particular the many times that she lies by using literally true but highly misleading statements, the mark of someone who knows she is lying but wants to be able to pretend otherwise.

The post appears in the blog of the “NYC Coalition for a Smoke-Free City”, an obviously misnamed group since they are campaigning not against smoke, but against e-cigarette use. The thesis is that NYC should go ahead with its proposal to prohibit e-cigarette use anywhere that smoking is prohibited. It is remarkable how close Healton comes to lying in every single sentence. The first few about the fact that NYC is about to act on this are true, but most everything that follows is a lie:

Who is the e-cigarette industry? Increasingly the e-cigarette industry is owned by the tobacco industry, an industry that would not be permitted to exist were it invented tomorrow because it would violate the consumer protection laws of all states and virtually every country in the world.

As I have pointed out, this “would not be allowed to exist” claim is at best pure speculation, and probably wrong. But apart from that, it refers to a product (cigarettes), not an industry. If the industry came into being right now selling low-risk products like smokeless tobacco, e-cigarettes, and NRT (all of which are sold by “the tobacco industry”), it would be allowed to exist. But, of course, this soup of words is not meant to analyze the actual claim, but to lie about e-cigarettes, suggesting they are some industry plot. In case the innuendo is lost on the reader, she goes on to lie,

For this reason, a healthy degree of skepticism about the industry’s ultimate goal in buying up e-cigarette manufacturers and creating more “efficient” e-cigarettes should prevail as policy makers establish regulations governing them. It is quite possible that the net effect of e-cigarettes will be to induce greater youth initiation of smoking and reduce the adult cessation rate, but the jury is still out.

I cannot imagine that Healton is stupid enough to actually believe that. It is impossible to come up with a story to explain why the existence of e-cigarettes (let alone the acquisition of a few companies that she led into that with) could cause smoking at all, let alone to cause a net increase in smoking initiation. E-cigarettes, like any popular low-risk alternative, will replace smoking initiation, not cause it.

Both youth and adult smoking rates are at their lowest levels in decades, so much is a stake for the health of the public.

Setting aside the fact that the “so” is a non sequitur, is what she is saying is that having almost 20% of the population smoking is such a success that harm reduction should be avoided? It appears so.

There is also much at stake for the tobacco industry as it seeks to apply its considerable marketing acumen and seemingly endless resources to maximize profit by increasing the number who start smoking by enticing youth worldwide to smoke and by trying to retain current smokers.

Complaining about “endless resources” is pretty funny coming from someone who is at the apex of the billions-per-year tobacco control industry. But the real question is what this passage has to do with e-cigarettes at all, let alone restricting where you can use them. It is typical tobacco control misdirection: “Cigarette manufacturers profit from more people smoking and remaining smokers, and therefore we should restrict where people can use e-cigarettes.” Huh??!

Who might be hurt by e-cigarettes? The tobacco products the industry has historically manufactured and promoted as “reduced harm” are not benign products created to meet the broad range of consumer preferences in the United States, rather they are deadly products that when used as directed kill over 400,000 Americans each year and are predicted by the World Health Organization to kill a billion people worldwide this century, 10 fold more than they killed in the 20th century. To put the scope of the current tobacco-related epidemic in perspective, in a few years, global lung cancer deaths will surpass AIDS deaths as the steady march of tobacco industry marketing continues to engulf the world’s poorest nations.

Again, huh??! Does anyone see any connection between that question and what follows? (Yes, I realize that the reader might now be questioning my assertion that Healton is too smart to not know she is lying.) Her allusion to historical products is the usual tobacco control canard about the introduction of “light” cigarettes four decades ago, products where there was no evidence to suggest they would be lower risk. And yet they were actively endorsed by the public health community, not just the manufacturers.

However, a mistake by everyone a couple of generations ago about what might be lower risk tells us nothing about the present world of products that are known to be lower risk. It is an utterly absurd and blatant lie to suggest otherwise.

None of what she says in this paragraph is true about the actual reduced harm products that have been introduced by the tobacco industry and by others. Smokeless tobacco, e-cigarettes, and other low-risk products do not cause the harms she is citing; cigarettes do. (Well, cigarettes cause and will cause a lot of harm, though not as much as she claims. But that is another story). She seems to be trying to invoke the conjunction lie, that cigarettes plus low-risk alternatives do that much harm (which implies the harm is shared, even though it is basically all caused by cigarettes), but she screws up doing even that. She actually is claiming that the low-risk products alone cause all the harm from smoking.

Nicotine addiction is in and of itself a gateway to tobacco product use because once addicted many will broaden the products they use and included among these will be the most dangerous products like cigars, cigarettes and hookah.

It is true that people who like to use one tobacco/nicotine product often try other products. But what she is trying to imply (carefully avoiding actually saying it) is that using e-cigarettes will cause people who would not have otherwise smoked to do so. There is no reason to believe this would be the case, and certainly no evidence of it occurring.

And it is worth pausing to remember that the title of this post says that NYC should include e-cigarettes in its smoking place restrictions. I have skipped a few sentences but have not left out anything that addresses that. There has been nothing yet. Even if the previous quote were not a lie, it would still only be an argument against letting kids use e-cigarettes, not about forbidding adults from using them at their desks or in bars.

Most tobacco-related deaths are the culmination of substantial suffering and societal cost from heart disease, emphysema or various cancers and are the direct result of nicotine addiction. Moreover, nicotine addiction is considered by many scientists as the most intractable of all addictions as measured by the percent of ever users who become addicted and the percent who remain addicted until death. Half of lifelong smokers lose their lives to tobacco addiction and among these people nearly half die before retirement age.

A pretty good argument in favor of encouraging e-cigarette use. The bit about “most intractable” is nonsense, of course. The reason users have more incentive to quit, say, meth than to quit smoking is the high level of short-term damage it is doing them. And the “half” is a made-up number that is higher than what the evidence suggests. Most important is that claims about the “addictiveness” of smoking tells us little about e-cigarettes, given the evidence that e-cigarettes are much easier to quit.

And, once again, this has nothing to do with whether there should be a place ban on e-cigarettes.

E-cigarettes are a complex product and their availability and the regulatory framework for governing them may have different implications and considerations for youth non-smokers compared to adult smokers. E-cigarette policy could produce sharply differing results by population sub-group. Data demonstrate that a significant swath of adolescents already are using e-cigarettes. Time will soon tell whether e-cigarettes function as one more point of entry to cigarette, cigar and hookah consumption among those using e-cigarettes initially. One thing is clear however, since cessation efforts have thus far not worked with teens, e-cigarettes will likely not do anything good for kids and may well entice many to start smoking in view of the broad array of sweet, candy flavors and slick e-cigarette marketing already blanketing the internet, mall kiosks, TV and radio, which have to date eluded regulation.

Blatant lies and clueless nonsense. (Ok, I will admit I am starting to doubt my previous assertion that Healton really understands what she is saying.) Skipping past the distractions that the first few sentences comprise, we have the lie that many adolescents are using e-cigarettes, a repeat of the lie that there is any reason they would cause smoking, the lie that because other cessation efforts do not work for kids that harm reduction will not work for them (it might be true, but probably is not, and it is nothing more than speculation asserted as fact), and of course the usual canard about marketing. Once again, the biggest lie here is that this has anything to do with restricting where adults can use e-cigarettes, or anything else about adult use.

Whether e-cigarettes will offer an incremental boost to cessation rates nationally also remains to be seen.

No, it doesn’t. Close to every e-cigarette user is either a former smoker or a current smoker who has replaced some smoking with e-cigarettes and could be persuaded to complete the transition. Many of those who quit smoking report that they had not been able to succeed at cessation until they tried e-cigarettes, and only then did they quit. Therefore e-cigarettes have increased cessation. This is not really a difficult concept to understand. (She goes on in that paragraph to lie about what the research shows, but I will stop at debunking her thesis claim.)

This is the epitome of the ANTZ tactic of declaring every negative they can concoct to be a real concern, even if there is zero evidence and even if the evidence clearly shows it is a non-issue, while denying every positive by pretending that the evidence does not exist.

We should also remain open to another highly plausible effect of e-cigarettes-that they will function in the same manner “light” cigarettes did when they were introduced in the 70′s, promoted by the tobacco industry as a step smokers could take to feel safer without actually quitting smoking. As many subsequent studies showed, in fact they were not safer and millions who would have quit had they not been introduced failed to do so costing innumerable lives.

And (setting aside the lies about “light” cigarettes themselves) there is that lie about the situations being similar again. The obvious difference is that e-cigarette users are “actually quitting smoking”, unlike light cigarette users, and they are using a product that genuinely is low risk. What does a public health failure of the 1970s have to do with e-cigarettes? Absolutely nothing. It is basically the same as saying leeches turned out to be harmful rather than helpful in treating infectious diseases, and therefore we should avoid antibiotics.

Do we really want everyone vaping where they once could smoke?

Oh, look, she is finally addressing the question she claims to be addressing.

The proposed extension of the SFAA to e-cigarettes, which will be voted on tomorrow, also will reduce the “walking billboard” effect of thousands of New Yorkers once again lighting up in bars, subways, parks, office buildings and restaurants throughout the city. But banning e-cigarettes in some locations solely for this reason is un-American in a country that prides itself on maximizing the freedom of its adult citizens to choose to engage in a range of risky and frisky behaviors.

Interesting. It is not a very risky behavior, of course, but it is nice to see that New York is still part of America.

The “billboard” claim is utter nonsense, of course. How is someone vaping in their office, rather than outside the front door, a billboard? E-cigarettes could still be restricted on the subway and restaurants could make their own choices about what is best for their patrons and vibe. The proposed ban would eliminate all discretion, reasonableness and common sense, going beyond a few specific restrictions that some might argue are reasonable and imposing rules that are clearly absurd and harmful.

Take a step back and see what she is doing with all of this. She is appealing to people who are worried about kids using e-cigarettes and do not like people vaping on the subway, and trying to trick them into supporting a rule that bars cannot choose to allow their patrons to vape. If she actually cared about kids and subways, she would propose something that affects kids (this rule would not) and would endorse a rule that just applies to the subways (which could probably be done by administrative fiat). Notice she never once offers any reason why banning vaping in bars, private offices, and many outdoor spaces would do any good for anyone, and indeed tries to hide the fact that this regulation would impose such restrictions. Classic tobacco control bait-and-switch.

It should be noted, however, that while we in general embrace this ethos, when it comes to public drinking we often do not. We do not embrace wandering down the street drinking a cocktail, hopping into the elevator rum and coke [sic] in hand or whipping out a flask of whiskey on a plane.

Ok, so no vaping on elevators and planes. I suspect that even most dedicated vapers would not find those to be terribly unreasonable restrictions. As for walking down that street, the street would be one of the few places vaping was still allowed under the restrictions. The anti-THR people cannot even keep their own stories straight.

Do we know enough to allow vaping in public spaces? So what are the real risks of public vaping? Is it as its promoters would like us to believe a benign, reduced harm practice that is at worst a passing fancy?

Um, no. Its promoters think it is here to stay. Also, the ban is mostly about private spaces, not public spaces.

Or is it a potentially toxic practice that places those in its immediate vicinity at risk. The answer is we do not completely know yet, although already studies have shown elevated nicotine levels among those exposed to secondhand vaping, and this in and of itself is ominous. Not definitively measured as yet among second hand vapers [sic] are the myriad other toxic substances which are contained in e-cigarettes.

Cute, huh, that use of “completely” and “definitively”. Of course we know, from ample evidence, with a very high degree of certainty that the risk to bystanders is zero or utterly trivial. But we never know anything completely or definitively. Someone can always use weasel words like that to intentionally trick the reader into thinking she made a statement about what we really know, rather than merely a statement about the fact that there is never proof or complete information in the real world.

And if anyone is aware of any study that shows elevated nicotine levels from people exposed to “secondhand vapor”, I would be quite interested in hearing about it.

Under these circumstances, the prudent course is to extend the SFAA to encompass e-cigarettes until, if ever, sufficient evidence exists demonstrating their safety.

Right. And what might that be? Oh, you say, no evidence would ever be sufficient for that. Thought so.

And why exactly would this be prudent? I do not think that word means what she thinks that word means. Is it prudent to restrict a very personal freedom when there appears to be no reason to do so, just because such a reason might be found later? (Sounds like an argument for banning, say, the building of mosques in America — there are many who would make the same “we just don’t know if this will hurt the children” arguments about that.) Is it prudent to ensure that cigarettes remain as attractive as possible as compared to low-risk alternatives?

The only conceivable downside of not extending the SFAA to e-cigarette use is the loss of any incremental harm reduction for smokers associated with being permitted to smoke e-cigarettes in locations where smoking is now banned.

TrANTZlation: The harm it would inflict on those not able to vape at their desk, in bars, etc. is of absolutely no consequence. We are tobacco control. We don’t actually care if tobacco users suffer. In fact, we prefer it.

And, of course, making e-cigarette use less attractive creates the public health harm of encouraging smokers to keep smoking.

It is highly unlikely that such a benefit, if it in fact exists, would outweigh the harms to youth, to non-smokers exposed to vaping nicotine laden vapors and potentially other toxins, and to recovering smokers who now stay quit in part because smoking has become less ubiquitous than it was 50 years ago when the Surgeon General released the first report on Smoking and Health.

Huh? It is highly unlikely? Care to quantify? I would love to hear about the harms to youth from people vaping at their desks. What harms are caused by (barely) “nicotine laden vapors”? What possible impact is there on “recovering smokers”?

Sadly e-cigarettes may lead to four negative outcomes: the initiation of more youth to nicotine dependence and subsequent conventional smoking; the use of e-cigarettes by current cigarette smokers who would otherwise have quit but instead use both conventional cigarettes and e-cigarettes in combination and therefore delay quitting or never quit and; the relapse to smoking by those who have already quit, first to smoking “benign” e-cigarettes and then to conventional cigarettes; and the exposure of people to e-cigarettes’ emissions unknown risks.

And how does all of this other than the last bit (a lie that has already been addressed) relate to the question at hand?

Who loses, if anyone, by extending the SFAA to e-cigarette use? Virtually no one loses. Vapers can still smoke everywhere current smokers now do. Let’s do what NYC has become known for and enact a policy that saves lives, not costs them.

Just in case the above trANTZlated passage was not clear enough, here she comes right out and says that the hardships suffered by vapers as a result of the rule do not matter. Smoking place restrictions are designed to make smokers less happy — tobacco control advocates generally admit that these days — so obviously imposing the same restrictions on vapers will make them less happy too. I wonder if it is a Freudian slip when she says that “vapers can still smoke” — because that is exactly what will happen: Some would-be vapers, upon having to go out to the smoking areas anyway, will indeed smoke. As a result, some of them will die from smoking and their blood will be on the hands of liars like Healton.

Today, a government committee in the state if Illinois is holding a hearing on THR. We should not expect anything to come from this since it is part of a series sponsored by RJR, with one expert testifying to a closed meeting which has demonstrated little traction in the past. They have failed to bring in the consumer perspective that a decade of failure coupled with CASAA’s successes has demonstrated is needed to turn the science into effective persuasion. (This is especially a shame since hundreds of vapers — living proof of the effectiveness of THR — are currently gathering in Chicago for VapeBash and would have been happy to drop by.)

One thing that these meetings do, however, is act as flypaper for the liars. In today’s case, Heather Eagleton, Illinois Director of Public Policy and Government Relations for the American Cancer Society Cancer Action Network (ACS CAN) laid on the lies so thick that it could have been a parody of the ANTZ position. Here are some excerpts:

The tobacco industry has marketed this new generation of smokeless tobacco products as a temporary way to deal with increasing cigarette taxes and smoke-free policies in public places. Despite the risks, these products, which include snus and dissolvables such as strips, orbs, and sticks, are being promoted by the tobacco industry as less harmful, more convenient, and more socially acceptable alternatives to traditional cigarettes. There is no scientific evidence that these products are safe, may be considered a safe substitute for, or are an effective means of quitting tobacco use.

Wow, where to even start?

Promoted by the industry as less harmful? If this were really true, these ANTZ would be filing lawsuits, not issuing lie-filled proclamations, since the industry is forbidden from making that claim no matter how obviously true it is. So the manufacturers are stuck with other messages, like “more convenient” and that it can be used anywhere, as their only ways to try to persuade smokers to switch to low-risk alternatives. As for objecting to “more socially acceptable”, apparently the ACS is now claiming that producing environmental tobacco smoke is socially acceptable — a bold move!

And, oh look, the classic strawman game of suggesting that someone is claiming that the products are perfectly safe, as an attempt to hide the clear evidence that they are about 99% safer. Some lies just never go out of style. This is naturally accompanied by the out-and-out lie that there is not overwhelming evidence that switching to these products is a proven very effective method of smoking cessation. With all of these lies, it seems hardly worth bringing up the absurd characterization of “new” for such products as snus, or even dissolvables (which ACS’s patrons in pharma have been selling for decades).

My favorite from this paragraph, though, just because it is not the usual lies, but a novel bit of stupidity, is the suggestion that these products are a “temporary way to deal with increasing cigarette taxes”. Huh? Is she claiming that cigarette taxes are expected to drop, so only a temporary response is needed? What she is definitely admitting is that cigarette taxes are not actually intended to incentivize smokers to reduce their risks, since otherwise switching products would be considered a success and not a failure.

There is research, however, to show these products cause cancer of the mouth, pancreas and esophagus, as well as other serious health conditions.

There is just one problem with that claim: the research actually shows that there is no such risk (nothing large enough to be measurable). You might think that the ACS had a competent scientist or two on staff who could actually understand the scientific literature. I wonder what they are doing with all that money that people give them?

So long as tobacco products continue to be responsible for nearly one out of every five deaths in America today, tobacco product manufacturers cannot pose as being the solution.

To paraphrase, so long as automobiles continue to be responsible for almost all roadway deaths in America today, auto manufacturers’ efforts to improve safety features cannot pose as being the solution.

This is a new twist on the old tobacco marketing campaigns of the 1960s, 1970s, and 1980s that falsely promised health benefits to be derived from filtered, “light”, and “less tar” tobacco product alternatives that were “more safe” versus “less safe.” These “harm reduction” messages were false then and are false now.

Ah, now there is a classic. Never mind that the public health community was the primary driver behind the light cigarettes failure. The current “public health” community wants to memory-hole that inconvenient fact. Just consider how faulty the parallel is: Light cigarettes were a speculative intervention, based on little more than guesswork, and turned out to be a failure. Smokeless tobacco products have been shown, after centuries of use and decades of research, to be low risk. Exactly how are these similar?

So the harm reduction messages, coming from both public health and the cigarette industry, were wrong in the 1970s, and therefore …um… no harm reduction message, no matter how overwhelmingly evidenced-based, can ever again be correct? Frankly, it might be a good tradeoff to use that as a basis for disregarding messages from the industry today, so long as we could also use it as a reason for disregarding every message from “public health” today. New rule: Anyone who has ever aggressively pushed a health message that turned out to be wrong is not allowed to talk anymore. And, yes, I am talking to you, ACS and Ms. Eagleton.

At the eighth meeting of the delegates to the World Health Organization’s (WHO’s) Framework Convention on Traffic Control (FCTC), delegates adopted Article 5.3, which forbids signatory governments from consultation and engagement with Big Auto and other parts of the automotive industry. Governments are also to act to ensure that independent researchers are also prevented from such engagement, using such mechanisms as political imprisonment, press censorship, and blacklisting.

The FCTC is devoted to ridding the world of the use of passenger cars by 2050 as part of WHO’s Social Programming to Eliminate Non-communicable Disease initiative. Automobiles are the leading cause of death in age groups from 4 to 50 years, and the second leading preventable cause of death in the world today. They are also the leading cause of obesity, exposure to second-hand smoke, and death and injuries among pedestrians and cyclists. In addition to their immediate health effects, automobiles are the leading contributor to global warming.

The automobile industry has a long-standing practice of influencing governments and manipulating consumers, including encouraging youth uptake, advertising in youth-targeted media such as television and magazines, selling vehicles that can achieve speeds far in excess of any legal speed limit, shutting down government-approved alternative transport, and covering up newly-discovered health threats. Indeed, the influence of the industry is so pervasive that one corrupted government recently provided a 13.6 billion euro ($17.4 billion) bailout of its domestic industry, rather than letting it fail as it should have done.

Article 5.3 also requires that all future automotive research on such topics and safety engineering should be entirely controlled by governments and FCTC’s approved list of public health researchers. Industry and those willing to constructively engage with them will be forbidden from conducting such research. Only by excluding the world’s best automotive engineers from the research process, replacing them with second-rate sociologists and medics, can public health’s goals be achieved.

The new rules are urgently needed due to the industry’s initiatives to substitute new “reduced risk” products, an attempt to attract new customers that can only be explained by our successful denormalization of driving. Recent attempts by automobile manufacturers to encourage “harm reduction” represent a blatant effort to make driving appear more acceptable. Industry wants consumers to continue to be addicted to these new products, rather than sticking with government-approved driving cessation methods like buses, trains, and reclusion, which are clinically proven to be successful for almost 5% of the population.

Despite the industry’s marketing claims, no randomized clinical trials have demonstrated that their new products are lower risk. Instead, these efforts recall the industry’s infamous “seat belt” fraud from the 1960s and 1970s, where they claimed that the installation of these features would reduce risk. In fact, subsequent research found that deaths and injuries from automobiles continued to increase worldwide, and are now skyrocketing. In recent testimony in Washington, former U.S. Surgeon General Richard Carmona reported, “No matter what you may hear today or read in press reports later, I cannot conclude that driving a new Subaru Forester, with all-wheel drive and computerized traction control, eight airbags, and a roll-cage-like reinforced chassis, is a safer alternative to a rusted-out 1971 Pinto.”

The new rule will bring all governments into alignment with FCTC policy. FCTC has always had a policy of forbidding involvement by the industry or automotive consumers, having recognized that perfect policy can only be made if interference by all the real stakeholders is avoided. Delegates are encouraged to never so much as converse with to anyone who considers motorized transport to be beneficial to people’s welfare, except in the context of clinical interventions.

FCTC recognizes that the industry will probably mobilize their front-groups to protest these rules, using their usual misleading language about “free choice” and “honest science”. The industry has a long history of creating fake grassroots support to claim that people simply prefer to drive in spite of the risks. But secret industry documents have revealed that every single person who expresses interest in cars is secretly in the pay of the industry.

Delegate, Michael Myers, CEO of the Campaign for Travel-Forbidden Kids, responded to these claims by industry-funded critics: “Individuals are persuaded by paid industry shills like Bruce Springsteen to consider cars to be cool or a way to look grown up. People who start driving as children become slaves to the industry. Almost none of them ever again go without owning a car after they become addicted. Motorized transport is far more addictive than heroin or even smoking. The only way to keep people from driving is to stop the industry from enticing them to start.”

This move by the FCTC follows on important anti-traffic efforts in several member states. The proposed Traffic Products Directive in the European Union would prevent any personal vehicle (PV) from traveling at faster than 30 kph (equivalent to 18.6 mph or 4 mg/ml). The US Department of Transportation requires that any automotive products either be “substantially equivalent” to technology that existed in 1980 and that any innovative products cannot be sold until 20 years of real-world data that proves their safety is accumulated.

The adoption of the new rule follows yesterday’s FCTC resolution to demand that governments devote all taxes collected on automobiles and gasoline, and other traffic-related taxes to anti-traffic efforts. Only 0.000185% of such taxes are given to anti-traffic QUANGOs, which drastically reduces the potential income of FCTC delegates. Indeed, the vast majority of the collections are devoted to maintaining roads and other actions that encourage driving, further evidence that governments are too heavily influenced by Big Auto. A related proposal, to demand the elimination of all depictions of automobiles in movies and television, based on the claim that it causes 483,921.4 children to start driving each year, was rejected as being too wackadoodle for even the FCTC.

The FCTC is an international treaty, with 183 signatory countries (which include 22 who actively wanted to sign, in addition to those who were blackmailed into it with threats of losing WHO funding). They are currently meeting in a 5-star resort hotel, thanks to revenue generated from a collection of extremely regressive taxes.

Press Contact: FCTC Secretariat, fax (yes, we really still do have a fax machine): +41 22 791 5830, or for those living in this century: fctcsecretariat@who.int

The title overstates a bit, but next week’s FDA hearings (official government announcement here) on whether to allow pharma nicotine products to be able to officially (“on label”) be used for long-term THR rather than just for the magical rapid weaning off of nicotine that they are supposed to accomplish. Since they are approximately useless for the latter and are mostly used for the former anyway, this is not a huge stretch. But recognizing the reality of THR would be a big step for the FDA, similar to what the UK’s MHRA has already done.

FDA is not really admitting that this opens the door to properly recognizing THR, but it does, and so several of us who are interested in THR are testifying on various points. Annoyingly, the government wanted us to submit not just our slides, but an actual text of our statements a week in advance. There are various conspiracy theories about the reason for that, but mostly I just find it a bother since I never write out the text of my talks, but usually put a lot of detail in the slides. But since I had to do it, I might as well make use of it here, so….

I am testifying as a private citizen and stakeholder, speaking for myself based on extensive professional experience and expertise. I am a long-time advocate and researcher on tobacco harm reduction. I have worked in this field for more than a decade as a researcher and educator, and have published roughly a million words on the topic. I am also an informed, consciously-motivated, occasional user of low-risk tobacco products, which I find to be quite beneficial, and clearly worth the unmeasurably small risk that they pose.

In response to Question 4.4, which asks about identifying harm in this context and identifying which harms are of particular importance, I have the following observations:

[Note: Full text is: 4.4. With regard to innovative products and treatments for “reduction in the harm associated with continued tobacco use”: a. How should the “harm” be identified and measured? b. Is there a range of harms that might be addressed, and if so, which are the most important to address?]

Harm should refer to actual harmful effects. This seems rather obviously, but there is a remarkable failure to follow this guideline in the discourse on this issue. Life-threatening disease risk is an important harm. Immediate problems of functioning are also an important harm. “Addiction” is not a harm in itself (even setting aside that it is not even scientifically defined). It might be a reason that people do something that actually causes harm, but it is only that actual harm that should be counted.

“Harm” must be considered in net term, as is done for treatment drugs or anything else the government properly regulates. Nothing is harm-free, but harm may be low (or trivial) compared to benefits. The common approach of naïve extremist activists approach, saying “this has a harm and therefore is bad” makes terrible public policy, but that is what you get if you do not consider full net costs and benefits.

To consider net effects, first requires considering the health benefits of using a tobacco harm reduction (THR) product as compared to abstinence. There are psychological benefits and aids to basic functioning from nicotine use for a non-trivial minority of the population, and this is a highly important consideration. Second, the net must consider health benefits that may not be considered “health”. Acting as if nicotine is purely a treatment for disease, rather than recognizing it as a consumer good that serves other preferences, is simply out of touch with the obvious reality. Many people use nicotine because they like the effects, and this is another highly important consideration. If the “D” side of FDA are not accustomed to dealing with such goods, perhaps those on the “F” side could help (or anyone else in government who regulates any non-drug consumer goods).

Third, net health benefits need to based on the probability-weighted “but for” choices. For example, if there is a 20% chance someone would be abstinent, but for the promotion of the THR option, and 80% they would continue smoke, then you need to compare any harms from the THR to .8 times the risk of smoking (a comparison that overwhelmingly favors the latter). It is simply out-and-out wrong thinking to compare the harm from one option to some unrealistic world that some people consider a best-case. This is not an odd concept: treatment drugs are evaluated based on their net effects, considering the harm from not getting the treatment. Moreover, the calculation of the net harm needs to recognize that some of the methods for pursuing abstinence (e.g., Chantix) are quite hazardous in themselves. And, most important, if someone tries to achieve abstinence but relapsing for a while, and as a result smokes for just a couple of more months, the resulting risk is (for the average smoker) greater than from than using a low-risk alternative for a lifetime, as I argued in my 2009 Harm Reduction Journal paper. This means that pursuit of abstinence is often a higher risk alternative to THR.

In response to Question 4.6, which asks about how FDA and other HHS agencies can help promote public health in this context,…

[Full text: 4.6 In regulating the innovative products and treatments referenced in section 918(b), how can FDA and other HHS Agencies act to ensure that the three effects mentioned in section 918(b)–total abstinence from tobacco use, reductions in consumption of tobacco, and reductions in the harm associated with continued tobacco use–are achieved as broader outcomes, in a manner that best protects and promotes the public health?]

…far and away the most important thing to do is:

Stop lying!

Units of HHS are the world’s biggest anti-THR liars, and have been since I started documenting anti-THR disinformation campaigns about a decade ago. The pervasive message to smokers about low risk tobacco and nicotine alternatives coming out of HHS has been and still is “you might as well smoke” (a phrase that was the title of my 2005 BMC Public Health paper that reports some of my research on this disinformation). FDA has now joined other agencies in publishing disinformation designed to discourage smokers from switching to low-risk alternatives by grossly exaggerating the risks of those alternatives using false and intentionally misleading claims.

These anti-THR messages encourage people to smoke when they would otherwise use a smoke-free alternative that poses risks that are two orders of magnitude lower. No conceivable amount of low-risk product usage could cause as much health harm as the smoking this causes. Following the phrases from Question 4.6, respectively “total abstinence from tobacco use” and “reductions in the harm associated with continued tobacco use”, the current practice of promoting the former at the expense of encouraging the latter is guaranteed to be bad for public health. Obvious and simple arithmetic makes that clear.

Regarding Question 4.7, about what to consider in FDA’s premarket evaluation of new product candidates,…

[Full text: 4.7. How can these broader outcomes be taken into account in FDA’s premarket evaluation of new product candidates?]

…I reiterate that focusing on the net on smoking is most important. Indeed, from a population health perspective, it is the only thing that matters. Everything else is a rounding error.

In addition, premarket evaluation depends on having a correct basic model for what motivates consumers to choose particular products. People act based on incentives which include health risks, of course, but also include many other factors. Consumers making choices are not mere patients – sick people seeking treatment for a disease and nothing more. If they are treated as such when predicting what they will do, the predictions will inevitably be wrong. Even worse, if they are just treated as black boxes who are assumed to just make choices at particular rates because that is sort of what other consumers did in the past under difference circumstances, then you will have garbage in yielding garbage out.

I have a lot more to say about this, but only seven minutes total, so that is where I will end.

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Just a quick aside today. I only just noticed the hilarious “warning” message on the shopping page SnusCentral.com: US Government Mandated Warnings for Americans: Depending on the month, this product can cause mouth cancer, can cause gum disease and tooth … Continue reading →

Some anti-THR activists are not willing to repeat the most blatant anti-THR lies, but they still need to concoct some reason for not supporting THR without admitting their true motives. One tactic is to claim that even though it is clear that THR is beneficial[*] for individual smokers, it still might be harmful at “the population level”. There is really no such thing “population level” health apart from individual health. Health (unlike social phenomena such as social cohesion or inequality) exists only as an individual phenomenon, and what happens at the population level exists only as an emergent phenomenon of what happens to individuals (thus the advantage of using agent-based modeling to study THR, as I posted recently).

[*Actually, I am not sure that tobacco control industry people, even those who are not willing to blatantly lie, would use a proper term like “beneficial”. They tend to stick to weasel words like “a reduced risk alternative for those who cannot quit” while working hard to avoid any phrasing that admits that people must be choosing the option because it offers them the greatest welfare among the available alternatives.]

If we unpack the “population level” rhetoric a bit, it is clear that it is really just a way of obscuring the statement, “we are afraid that more people will use tobacco/nicotine when they find out they can do so with very little risk”. This is undoubtedly true (that it will happen) — people are not morons, after all, despite what the ANTZ claim. But is it really the case that we are unsure whether the average/aggregate population health effects will be positive or negative? No. It is obvious that the effects will be positive.

A good way to recognize someone who really thinks like a scientist and is seeking the truth, as opposed to someone who either does not understand how to do science or is intentionally trying to obscure the truth, is how he deals with orders-of-magnitude differences. A scientist, as a matter of second nature, sets aside considerations that are too small to matter (after doing whatever it takes to ensure this is the case). Typically some of these smaller considerations will be included in a scientific model because there is no reason to leave them out, but there will be no suggestion that they might substantially alter the main phenomenon of interest.

There is a classic illustrative joke. A museum visitor asks a guard how old a particular fossil is. The guard replies “two million and seven years”. When asked by the baffled visitor how such precision is possible, the guard replies, “Well, when I started working here they told me it was two million years old, and that was seven years ago, so….” We might hope that even a security guard, after hanging around researchers for seven years, would understand the concept of rounding error in this context. But since it is pretty clear that most of the “scientists” who dominate public health and health reporters never seem to learn this grade-school-level science lesson, maybe this is too optimistic.

A scientist, when addressing the population average effects of promoting THR, would quickly recognize that what matters is how the THR effort affects the smoking rate. Almost everything else is a rounding error. Anyone who worries about finicky details — like exactly how many people will be using THR who would have otherwise been abstinent — is either (a) not actually concerned about health, and is using it to hide her real motives, or (b) is functionally innumerate.

Smokeless tobacco is about 99% (+/-1%) less harmful than smoking, and other smoke-free alternatives (e-cigarettes, pharma products) are similar (they might be a bit worse, but it would be shocking if any of them turned out to cause even 5% of the risk from smoking). Thus, the number of people using THR rather than being abstinent that would be needed to make a dent in the net benefits from one person switching from smoking is quite large. In fact, it is so large that the count of such people does not really even matter. It is a rounding error. Mis-estimating the reduction in smoking by 1% (which is pretty much inevitable) swamps the implications of that other estimate, so what really matters is improving the accuracy of the smoking reduction estimate.

Notice that I said this is almost the only thing that matters. The only other number that has effects that are not swamped by uncertainty and rounding errors in the smoking rate (i.e., the only number that is worth not ignoring) is the impact of THR on causing some smokers to reduce but not eliminate their smoking. Reducing smoking intensity reduces risk, though less than linearly (i.e., cutting down by half reduces your risk, but the reduction is by less than half). So the number of smokers partially adopting THR, and how much they reduce their smoking, could have an effect worth measuring.

But notice that this points in the same direction as the main effect: a reduction in smoking and thus a substantial reduction in average risk in the population. The rate of use of THR alternatives is not even worth measuring when asking the question “are we sure the net effect is positive?”

The ANTZ rhetoric surrounding this issue often includes claims about how THR will cause some people to take up smoking, but there is no apparent way in which promoting something as a better alternative to smoking could lead to smoking. The existence of smoke-free products might keep more people smoking — it tends to interfere with the efforts to torment smokers with place restrictions (prohibitions against smoking in certain places) because they can temporize with the smoke-free alternative. Setting aside the unethical nature of such tactics, they undoubtedly work to some extent (they are akin to The Inquisition or criminalizing consensual sex — it is possible to torture or threaten someone enough that they will give up something that is very important to them). But the actual promotion of THR, rather than just the existence of the products, has no such effect. Besides, since no one has ever suggested banning all smoke-free nicotine products (including pharma products, which are often used to minimize the torment of place restrictions), it is difficult to believe that anyone is really motivated by this.

The context where this “population level” myth shows up most importantly is in US FDA policy, which will not allow a manufacturer to make claims about something being lower risk than smoking until the “population effect” is researched. Thus, it is THR — not the product itself — that the “population level” myth is being used to interfere with.

With all that in mind, there is one apparent way in which education about THR could cause someone to smoke more than he otherwise would: It could be that someone’s utility from abstinence would have been higher than that from smoking (so he would have quite entirely given only those options) but that the utility from reducing smoking to take advantage of some THR but then continuing to smoke is higher still. Is that a plausible scenario, something other than an occasional curiosity? Addressing that requires thinking about the utility function that measures the costs and benefits from smoking, something that the ANTZ and those dependent on their funding will probably never do (because they like to pretend there are no benefits). I will let you know when I make some progress on the question.

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I am outsourcing to myself today. I just posted, at my EP-ology blog, a video of a talk I gave last week which presented a social-dynamics-based model of the spread of THR adoption in a population. The video speaks for itself and my other post contains more details about the modeling, so I will offer only the briefest of summaries here and then emphasize a few points about how it relates to anti-THR lies.

The video starts with a general background about THR and the case for it. Early feedback is that this is a particularly good version of that, so you might be interested in that part alone. As for the new model, it shows how adoption of e-cigarettes moves like a contagion through a population (though unlike a simple disease contagion, it involves individuals learning and making rational economic decisions).

The premise of the modeling challenges one of the fundamental anti-THR lies, the claim that smokers are not making a choice to smoke and that somehow they are just accidentally doing it: You cannot model individual choice without recognizing that individuals are choosing. And you cannot model that without recognizing that they are rationally choosing what seems best for themselves. Whatever exactly “most smokers want to quit means” (I have written about that previously), it clearly does not mean “prefer to not smoke today when offered the choice”, because they obviously are offered the choice.

A model of deciding to switch to THR requires recognizing that smokers are making that choice because they want to, which means that the benefits exceed the costs. The very existence of what is represented by each of those words in italics is denied by most the anti-THR liars and other ANTZ. Their entire deadly game is premised on the denial of those concepts.

Of course, an analysis cannot demonstrate its own premises. I have to assume that is a lie to be able to even do the work. But the model’s output does demonstrate the wrongness of another claim: There is a classic anti-THR claim that THR is not worth pursuing because not too many smokers are interested in it. The basis for that claim was that not too many have adopted THR (except in a few places like Sweden). I do not hear this very often any more. Maybe the ANTZ have given it up, though they probably still repeat it in their echo chambers, where every lie, no matter how thoroughly debunked, lives on as a zombie. I fact, at the same conference where I gave the talk, I was astonished to hear one of the attendees dredge up that moronic, obviously false, and even explicitly debunked claim that THR is like jumping from a 5th floor window rather than 10th floor. But I digress…

The claim of little interest is obviously a stupid excuse for an argument against encouraging THR. Just because most people do not eat enough vegetables does not mean that we stop pointing out that it would be a healthy choice to make. Beyond the silly “we should not try” claim, though, the model shows why it is wrong to even think “we should not be optimistic” (though perhaps an honest mistake and not a lie, because the reasoning necessary is a bit tricky — thus the model).

The model shows that adoption of THR will typically slowly increase over a long period of time and then reach a tipping point and jump up sharply. This is not an artifact of particular details of the model design — it happens pretty much no matter what details are used. This means that the fact that only, say, 5% of smokers have adopted THR as of now does not mean that it will not hit 60% within a couple of years. The abstract model cannot show that this will happen, of course, but it shows that something like that seems very likely at some point in the adoption of THR.

The model also demonstrates that a constant low-level anti-THR campaign (or a campaign against a particular THR product category) can dramatically delay the time at which the tipping happens. In other words — in keeping with what many of us have been saying all along — the reason THR has not been more successful yet is that the ANTZ have delayed it. The lack of massive uptake to date is not an argument against promoting THR; rather it is an argument against their behavior.

To put that in context and for more details, follow the link and watch the video.

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Tobacco Harm Reduction (THR)

THR is the public health strategy of encouraging smokers to switch to low-risk alternatives like smokeless tobacco and e-cigarettes. It is the only proven method for reducing smoking below about a fifth of the population once it becomes established. (So why would anyone be anti-THR? See the "About" page.)

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The continuing scourge of [smoking]-produced disease is unlikely to yield to today’s "evidence-based" interventions. (scare quotes added) Kenneth E Warner; see post if the implications are not obvious

If someone says the sky is green, you prove that it’s actually blue, and the next day he comes back once again insisting that the sky is green, and this happens repeatedly, you eventually have to acknowledge that mannerly debate about the color of the sky just isn’t enough; you have to go meta, and talk about the fact that this guy and his friends just aren’t in the business of honest discussion. Paul Krugman

He who is merciful to the cruel will become cruel to the merciful. Ancient Midrash